| NPI | 1134469141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN 5006) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A3871) |
| Enumeration Date | 2013-02-28 |
| Last Update Date | 2013-02-28 |