| NPI | 1356739080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2050823) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: KY A03000) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2018-08-22 |