| NPI | 1255675633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA PTA3850) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: RI PTA00737) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2023-08-03 |