| NPI | 1649650029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160007679) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO 0013611) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2021-03-23 |