| NPI | 1538520846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA003791) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A1759) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2024-08-02 |