| NPI | 1215775473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A8009) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 011909-01) |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2024-09-26 |