| NPI | 1720652480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA002869) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 5098) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-05-18 |