| NPI | 1619375441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV 002023) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A03254) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2014-12-10 |