| NPI | 1912606799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 32596) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 5043) |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-03-01 |