| NPI | 1962228130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC 7264) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306606052) |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2024-12-03 |