| NPI | 1164279170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID 4146) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 9255) |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-05-06 |