| NPI | 1952995102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A5566) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-10-15 |