| NPI | 1346964533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO CP015268A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA013364) |
| Enumeration Date | 2022-09-30 |
| Last Update Date | 2022-10-23 |