| NPI | 1508541459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 1404119) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS T-05910) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2023-07-27 |