| NPI | 1447428826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN PTA0000004252) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TN 5115) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2025-10-04 |