| NPI | 1225763576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA004367) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA29793) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-07-20 |