| NPI | 1639362809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306001152) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: VA 0002040749) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |