| NPI | 1124793526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD CP049326A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: DE CP046429A) |
| 225200000X Physical Therapy Assistant (Licence: WA P161197355) | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2025-09-04 |