| NPI | 1578737623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AR 2258) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 3178) |
| Enumeration Date | 2008-04-19 |
| Last Update Date | 2013-06-07 |