| NPI | 1972081040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 9414) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CT 1473) |
| 225200000X Physical Therapy Assistant (Licence: NY 009447) | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |