| NPI | 1912246836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AR 2395) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2053502) |
| 225200000X Physical Therapy Assistant (Licence: LA A6771R) | |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2013-02-13 |