| NPI | 1760070429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A7101) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 4309) |
| 225200000X Physical Therapy Assistant (Licence: VT 041.0133906) | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-01-07 |