| NPI | 1215645411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE013641) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 013318-01) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2024-08-09 |