| NPI | 1831655240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2023208) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: TX 2023208) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2019-02-11 |