| NPI | 1982704029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306001175) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119003159) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |