| NPI | 1215502802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI000240) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: RI TEI000240) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |