| NPI | 1174741557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MS PTA2379) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MS OT1963) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |