| NPI | 1629494166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 001263) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: RI PTA00870) |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2014-03-07 |