| NPI | 1912279589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NE 940) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 001530) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |