| NPI | 1699280230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA003434) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PTA003434) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2021-05-20 |