| NPI | 1184442709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OK 2970) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC A8125) |
| 225200000X Physical Therapy Assistant (Licence: AZ 014468) | |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2024-10-02 |