| NPI | 1902339161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306604669) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502003575) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2017-04-05 |