| NPI | 1205372208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN PTA0000006466) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2010016623) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2023-08-07 |