| NPI | 1295190395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 008747) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC A5477) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |