| NPI | 1942668512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 1654) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC A3968) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2016-02-10 |