| NPI | 1619393808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA004475) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 3035) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2020-08-24 |