| NPI | 1245563667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-0175) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2005003632) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2009-09-17 |