| NPI | 1750853982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC 3342) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2019-10-25 |