| NPI | 1609499367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2153461) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA18908) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2020-05-28 |