| NPI | 1881352516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA CP008628A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2136779) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2021-11-30 |