| NPI | 1710364666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NH 1185) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 34019) |
| 225200000X Physical Therapy Assistant (Licence: FL 24732) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |