| NPI | 1649823782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13888) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: NC 18418) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2024-01-29 |