| NPI | 1942920749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2022036737) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-04020) |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2022-09-13 |