| NPI | 1174190953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P161441541) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA28243) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2023-07-31 |