| NPI | 1598221806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM PT-2023-2288) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A3485) |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-08-01 |