| NPI | 1588034664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-02887) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2115841) |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2015-10-01 |