| NPI | 1245095058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2181161) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA32617) |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2024-04-24 |