| NPI | 1770738031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE007913) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2065120) |
| Enumeration Date | 2008-11-29 |
| Last Update Date | 2008-11-29 |