| NPI | 1548751597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 50633) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502004870) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2023-11-02 |