| NPI | 1417499898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 20548) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 9264) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2016-11-16 |