| NPI | 1124815691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV 002579) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 012577) |
| 225200000X Physical Therapy Assistant (Licence: NH CP043668A) | |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-04-23 |