| NPI | 1235699588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 21456) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 89) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2021-06-28 |