| NPI | 1053658120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI003611) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE009352) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2018-10-09 |