| NPI | 1093427601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: DC PTA2000040DC) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A5771) |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2025-07-09 |