| NPI | 1851789374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2013041292) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-02561) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |