| NPI | 1861943094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: DC PTA000148) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 48061) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2016-10-24 |