| NPI | 1235839705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502005544) |
| 225200000X Physical Therapy Assistant (Licence: OR 10057) | |
| 225200000X Physical Therapy Assistant (Licence: MD A5728) | |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2024-08-10 |