| NPI | 1245974591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 31618) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-04-25 |