| NPI | 1174912117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY A02533) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06004945A) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-01-14 |