| NPI | 1285803783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MT 1356) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2061599) |
| 225200000X Physical Therapy Assistant (Licence: AR 2111) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2008-02-28 |