| NPI | 1326784323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEl004870) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTA18668) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-05-11 |