NPI | 1043726201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL PTA28080) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA28080) |
Enumeration Date | 2017-12-22 |
Last Update Date | 2025-02-12 |