| NPI | 1346009164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ PTA-014529) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO CP029887A) |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-03-14 |