| NPI | 1194256495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 2122) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 27272) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-08-29 |