| NPI | 1285138446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 11433) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A4829) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2018-03-22 |