| NPI | 1184459513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2018032905) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-03420) |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2024-09-05 |