| NPI | 1639641061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE1004937) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A5054) |
| Enumeration Date | 2018-12-25 |
| Last Update Date | 2020-12-14 |