| NPI | 1851545776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2034833) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 0272A) |
| 225200000X Physical Therapy Assistant (Licence: CA AT6600) | |
| 225200000X Physical Therapy Assistant (Licence: FL PTA20242) | |
| 225200000X Physical Therapy Assistant (Licence: ID PTA2293) | |
| 225200000X Physical Therapy Assistant (Licence: MT 2140PTA) | |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2008-11-05 |