| NPI | 1356930572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2187836) |
| Additional Taxonomies | 183700000X Pharmacy Technician |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2025-09-15 |