| NPI | 1225230519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AL PTA 4763) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA 20803) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2025-09-11 |