| NPI | 1659120483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE013514) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AK 228151) |
| 225200000X Physical Therapy Assistant (Licence: CO PTA.0015525) | |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2024-09-18 |