| NPI | 1194922096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 9445) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: RI PTA 00506) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2018-04-26 |