| NPI | 1689968414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID 2215) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 2724) |
| 225200000X Physical Therapy Assistant (Licence: AR 2334) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2011-06-09 |