| NPI | 1811676067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A7149) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA30970) |
| 225200000X Physical Therapy Assistant (Licence: WA CP022572A) | |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-07-14 |