| NPI | 1659578557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 8463) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MT 1353) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2007-07-08 |