| NPI | 1750689303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NH 0579) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NH 0382) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2011-03-07 |