| NPI | 1184388381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 010113) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 31661) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2021-12-14 |