| NPI | 1922499037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2032712) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 791873) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |