| NPI | 1013632942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV PTA002743) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TEI005037) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2022-10-04 |