| NPI | 1225756497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NH 1405) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA CP023011a) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2024-09-09 |