| NPI | 1952053613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 10094) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA30416) |
| 225200000X Physical Therapy Assistant (Licence: CT 2233) | |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2023-03-07 |