| NPI | 1073491775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A8659) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA23600) |
| Enumeration Date | 2025-08-22 |
| Last Update Date | 2025-08-27 |