| NPI | 1568901080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID 5400) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 1565) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2021-08-28 |