| NPI | 1578920021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC 3032) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2109985) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |