| NPI | 1932530359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA 3205) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL 4949) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2014-10-08 |