| NPI | 1942949979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502005997) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 10028) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-05-27 |