| NPI | 1790335040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA004325) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A5153) |
| 225200000X Physical Therapy Assistant (Licence: FL PTA22256) | |
| 225200000X Physical Therapy Assistant (Licence: TX 2145364) | |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2019-09-18 |