| NPI | 1346027265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 49845) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A3958) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2023-09-13 |