| NPI | 1972915114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NE 1168) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 09030) |
| 225200000X Physical Therapy Assistant (Licence: VA 2306603505) | |
| 225200000X Physical Therapy Assistant (Licence: IA 005007) | |
| 225200000X Physical Therapy Assistant (Licence: ID 3378) | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2014-05-22 |