| NPI | 1679903157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306603748) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CT 000346) |
| 225200000X Physical Therapy Assistant (Licence: MA 3385) | |
| 225200000X Physical Therapy Assistant (Licence: NH 0576) | |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2013-11-19 |