| NPI | 1639680390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 9266A) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: AZ 9266A) |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2017-10-20 |