| NPI | 1437687969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MS CP001159A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 5828) |
| 225200000X Physical Therapy Assistant (Licence: TN 5825) | |
| Enumeration Date | 2017-05-29 |
| Last Update Date | 2020-02-05 |