| NPI | 1326697467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 00064) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified (Licence: IA 00019) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2019-09-11 |