| NPI | 1063803500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 9462APTA) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO PTA0013022) |
| 225200000X Physical Therapy Assistant (Licence: MT PTP-PTA-LIC-5973) | |
| 225200000X Physical Therapy Assistant (Licence: NM A-0901) | |
| 225200000X Physical Therapy Assistant (Licence: WA P160320311) | |
| 225200000X Physical Therapy Assistant (Licence: WY 0799) | |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2015-02-05 |