| NPI | 1205269123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV PTA 000672) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY PTA 000423) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2013-08-14 |