| NPI | 1366701187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV 001753) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A3226) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2012-05-14 |