| NPI | 1689874646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2048956) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 2048956) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2007-07-18 |