| NPI | 1194582577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 014164-01) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306606265) |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-08-02 |