| NPI | 1215672621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR CP004282A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2155382) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2022-05-02 |