| NPI | 1447794334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV 002117) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE011118) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-12 |