| NPI | 1033735253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NH 0338) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VT 041-0000326) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |