| NPI | 1467933390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2094326) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 292870) |
| 225200000X Physical Therapy Assistant (Licence: NY 008635) | |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2018-08-28 |