| NPI | 1083416549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2187598) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT137456) |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-03-26 |