| NPI | 1144927500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 10135) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ PTA-014606) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2023-02-15 |