| NPI | 1982886164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 08178) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NH 0919) |
| 225200000X Physical Therapy Assistant (Licence: NY PTA 19559) | |
| 225200000X Physical Therapy Assistant (Licence: VT 041-0000545) | |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2007-11-29 |