| NPI | 1932427770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OK 1802) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 2626) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-05-04 |