| NPI | 1912305145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2109609) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 009654) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2021-11-08 |