| NPI | 1972841096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 2138) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC A4991) |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2020-12-22 |