| NPI | 1376217190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2021037964) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-03836) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2026-05-27 |