| NPI | 1447901442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2020038101) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OK 2559) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-01-12 |