| NPI | 1588940373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A1239) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: MD A1239) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |