| NPI | 1801464946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA004694) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA 123456) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2022-06-08 |