| NPI | 1891276952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: 2090847) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2018-08-27 |