| NPI | 1508379108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-03270) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2017033102) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2017-11-06 |