| NPI | 1568675189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2033181) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160-002759) |
| 225200000X Physical Therapy Assistant (Licence: GA PTA001235) | |
| 225200000X Physical Therapy Assistant (Licence: NV A-0411) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2014-10-03 |