| NPI | 1942784806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2122305) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WY 0917) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |