| NPI | 1922275130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306601817) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 6897) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2023-03-29 |