| NPI | 1770813172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2070249) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MT 2191) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2010-01-06 |