| NPI | 1679084800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY A03721) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 29785) |
| Enumeration Date | 2017-10-15 |
| Last Update Date | 2021-06-25 |