| NPI | 1962198028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: LA A7495) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2166645) |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |