| NPI | 1255085593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2022003376) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-03800) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-02-07 |