| NPI | 1205039328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 0117005352) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA002323) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |