| NPI | 1912312877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502004184) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 009011-1) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2014-06-30 |