| NPI | 1699226506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM PT-2023-2389) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06006588A) |
| 225200000X Physical Therapy Assistant (Licence: WI 2561-19) | |
| 225200000X Physical Therapy Assistant (Licence: MA 10061) | |
| 225200000X Physical Therapy Assistant (Licence: CT 2349) | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2023-12-20 |