| NPI | 1366561011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA002060) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE007060) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2022-07-21 |