| NPI | 1114574027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 17133) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2026-07-13 |