| NPI | 1215367545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P160288364) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: UT 3506292402) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2013-11-22 |