| NPI | 1720793771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2028975) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NM A1051) |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2023-01-13 |