| NPI | 1679078331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 09469) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: UT 8177960-2402) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2018-03-26 |