| NPI | 1861029670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A4807) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA27557) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-03-24 |