| NPI | 1578721577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ME PA2516) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NH 0928) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |