| NPI | 1184137317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NE 1554) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 087090) |
| 225200000X Physical Therapy Assistant (Licence: NM A-1398) | |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2017-11-09 |