| NPI | 1902216062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-02588) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 1235) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2014-04-29 |