| NPI | 1407328917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502002609) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 5502002609) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2018-12-20 |