| NPI | 1487963187 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 8149) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NH 0908) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2010-09-28 |