| NPI | 1619572310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 30480) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL 30480) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2021-06-29 |