| NPI | 1003282773 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VT 041.0111788) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NH 1197) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2015-08-18 |