| NPI | 1013327212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 8736) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VT 041.0101445) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2014-04-28 |