| NPI | 1811403504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A6319) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2017-12-18 |