| NPI | 1609300706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA000912) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 3725) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2017-04-14 |