| NPI | 1700370046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 30841) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO 0014385) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-04-05 |