| NPI | 1578866463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NV A-0362) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT 2356) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |