| NPI | 1700402559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 4802953) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5502005126) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-28 |