| NPI | 1336511799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC 2696) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA003677) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2022-01-05 |