| NPI | 1699523589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NE 1801) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA CP030858A) |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-05-07 |