| NPI | 1760067037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A8243) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 3674) |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2023-12-14 |