| NPI | 1093139545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2185782) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 10688A) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2026-04-01 |