| NPI | 1558769166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IN 06004845A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 1726-19) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2014-12-12 |