NPI | 1013531466 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA29849) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9664631) |
Enumeration Date | 2020-06-02 |
Last Update Date | 2025-08-19 |