| NPI | 1326594243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 48919) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06005233a) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2019-08-08 |