| NPI | 1417847971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 002310) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306606738) |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2025-07-07 |