| NPI | 1104682178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ PTA-000181) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 000181) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-02-26 |