| NPI | 1184130767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A7068) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 007876-1) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2023-10-03 |