| NPI | 1053771444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 073664) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160.006963) |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2016-02-29 |