| NPI | 1831500149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2086860) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: LA A7698) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2014-05-09 |