| NPI | 1104314517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2137140) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2018-05-01 |