| NPI | 1023830841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: UT 8052147-2402) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: UT 8052147-4701) |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-10-31 |