| NPI | 1972859312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MS 4271) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL 42621) |
| 225200000X Physical Therapy Assistant (Licence: TX 2088128) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2012-08-02 |