| NPI | 1801399183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OK 2533) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2018-03-13 |