| NPI | 1922414804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 24797) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WV 1202) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2014-07-11 |