| NPI | 1770268104 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WV PTA002689) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-06-21 |