| NPI | 1386356574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA CP017149A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC A7715) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |