| NPI | 1144945114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV 002419) |
| Additional Taxonomies | 251E00000X Home Health (Licence: WV 002419) |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2023-11-29 |