| NPI | 1649538653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 8627) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: RI PTA00847) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2012-04-26 |