| NPI | 1811587496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306606358) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTA30356) |
| 225200000X Physical Therapy Assistant (Licence: MA 10075) | |
| 225200000X Physical Therapy Assistant (Licence: OR 10174) | |
| 225200000X Physical Therapy Assistant (Licence: MT 27010) | |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2023-07-05 |