| NPI | 1083813612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE000656L) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: PA OP001918L) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2007-07-13 |