| NPI | 1750960225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2012038322) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-02459) |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2022-11-14 |