| NPI | 1174923833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA005151) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA 24813) |
| Enumeration Date | 2014-09-01 |
| Last Update Date | 2025-12-19 |