| NPI | 1265861280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A1890) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY A1890) |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2013-11-12 |