| NPI | 1003487133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI002759) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA TEI002759) |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2021-07-21 |