| NPI | 1801341946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2119263) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 2716) |
| 225200000X Physical Therapy Assistant (Licence: AZ 12350A) | |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |