| NPI | 1427663848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 0015181) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 30141) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2022-06-01 |