| NPI | 1447992169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2022-04-12 |