| NPI | 1962941815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 09430) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 1419) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2020-11-13 |