| NPI | 1467987297 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA 002487) | 
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 23079) | 
| Enumeration Date | 2017-04-30 | 
| Last Update Date | 2022-01-06 |