| NPI | 1013476977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 52753) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 29060) |
| 225200000X Physical Therapy Assistant (Licence: MA 10083-AH-PA) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-03-18 |