| NPI | 1265975684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 012511) |
| Additional Taxonomies | 251E00000X Home Health |
| 225200000X Physical Therapy Assistant (Licence: TN PTA0000006080) | |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2023-04-19 |