| NPI | 1477907152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 48001) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2107426) |
| 225200000X Physical Therapy Assistant (Licence: NY 009592-1) | |
| 225200000X Physical Therapy Assistant (Licence: PA TE010180) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2016-04-19 |