| NPI | 1780708990 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: DE J2-0000404) | 
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE007091) | 
| Enumeration Date | 2007-03-16 | 
| Last Update Date | 2007-07-08 |