| NPI | 1578647012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2092898) |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 36001064A) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2014-12-30 |