| NPI | 1528412780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2117208) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 09238) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-14 |