| NPI | 1912331687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 0013209) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 08985) |
| 225200000X Physical Therapy Assistant (Licence: TX 2099250) | |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2013-08-29 |