| NPI | 1619161296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC 2124) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2007-08-28 |