| NPI | 1710568209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A7461) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC PTA.4569) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2021-04-16 |