| NPI | 1619588035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IN 06005979A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2151091) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2020-08-10 |