| NPI | 1982357125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: UT 12557040-8019) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2022-01-28 |