| NPI | 1518533470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA004661) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502006331) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2021-06-01 |