| NPI | 1548668437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 0013470) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 9879) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |