| NPI | 1356685853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 23697) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD 3670) |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2018-03-17 |