| NPI | 1457019994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO CP008788A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 1374) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2021-12-13 |