| NPI | 1346614500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NH 391) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 2763) |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |