| NPI | 1184985954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OK PTA1862) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR PTA1652) |
| 225200000X Physical Therapy Assistant (Licence: TX PTA2070308) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2012-06-07 |