| NPI | 1033659818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2091671) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: TX ATP87911) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |