| NPI | 1417739020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306606453) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012356) |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-11-02 |