| NPI | 1275360232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 53045) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2181592) |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2024-09-16 |