| NPI | 1871727115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: DC PTA000014) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A2565) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2024-01-02 |