| NPI | 1619967148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE000241L) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC002460L) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2007-07-08 |