| NPI | 1053051995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL pta23006) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 23006) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-03-30 |