| NPI | 1104419555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 0015219) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 30448) |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2022-09-09 |