| NPI | 1407201437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A5816) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306604367) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2016-04-27 |