| NPI | 1518679455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306605971) |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2023-01-11 |