| NPI | 1295138113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ME PA3667) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 8742) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2014-10-06 |