| NPI | 1518294388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 20576) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 2370) |
| Enumeration Date | 2009-11-15 |
| Last Update Date | 2009-11-15 |