| NPI | 1801315551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC CP001369T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292550) |
| 225100000X Physical Therapist (Licence: TN 11100) | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2020-03-13 |