| NPI | 1093172223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA AT8212) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: CA AT8212) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |