| NPI | 1487945903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: RI pta00322) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI rn40640) |
| 163W00000X Registered Nurse (Licence: MA rn263756) | |
| 225200000X Physical Therapy Assistant (Licence: MA pta4189) | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2011-05-02 |