| NPI | 1124700901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD CP024266A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2162277) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-08-16 |