| NPI | 1811720550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID 3061178) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: ME PA6882) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-08-20 |