| NPI | 1467925453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A5013) |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2019-05-01 |