| NPI | 1902198757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-02254) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2020-12-12 |