| NPI | 1255218988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 47920) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |