| NPI | 1487332474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502006880) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: 5502006880) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2023-07-10 |