| NPI | 1477346245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 50378) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 29582) |
| Enumeration Date | 2025-05-26 |
| Last Update Date | 2025-05-26 |