| NPI | 1356508824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN 0000003427) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY a01823) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2014-09-24 |