| NPI | 1265164495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2022029904) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-03964) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2022-07-29 |