| NPI | 1346984861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 27043) |
| Additional Taxonomies | 2081H0002X (Licence: FL 27043) |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2022-04-21 |