| NPI | 1083067359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC 5496) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 3223) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |