| NPI | 1396045381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A1383) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE1000405) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2010-10-25 |