| NPI | 1336345305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM A-0930) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NM a-235) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2013-12-18 |