| NPI | 1932556040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY A04065) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306603085) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2019-11-22 |