| NPI | 1538028154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2143463) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A749) |
| Enumeration Date | 2026-01-20 |
| Last Update Date | 2026-01-20 |