| NPI | 1073996013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2102866) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 5457) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |