| NPI | 1912539487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306605287) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 5641) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2020-03-12 |