| NPI | 1528729514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306606527) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012961) |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2024-09-04 |