| NPI | 1134695216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NE 935) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 001460) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2024-11-11 |