| NPI | 1326638404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ PTA-014327) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2159704) |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2023-03-31 |