| NPI | 1164456075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC 669) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA CP024458A) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-09-21 |