| NPI | 1912209933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ME PA3433) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2068690) |
| 225200000X Physical Therapy Assistant (Licence: PA TE008225) | |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2010-11-23 |