| NPI | 1083171409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2017029129) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KS 14-03258) |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2022-05-05 |