| NPI | 1154133320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 53802) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00407600) |
| Enumeration Date | 2025-01-23 |
| Last Update Date | 2025-05-29 |