| NPI | 1730609801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 27522) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 09485) |
| 225200000X Physical Therapy Assistant (Licence: NC 6281) | |
| 225200000X Physical Therapy Assistant (Licence: TX 2129076) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-07-21 |