| NPI | 1932742202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA CP005018A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 50253) |
| Enumeration Date | 2019-10-19 |
| Last Update Date | 2021-06-10 |