| 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 |