| NPI | 1922477074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2087427) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 008138) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2016-08-24 |