| NPI | 1407498611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ME PA6094) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 011521-1) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2021-11-08 |