| NPI | 1407519879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA004816) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502006446) |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2024-03-27 |