| NPI | 1568142511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC PTA.5277) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE013444) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2024-06-07 |