| NPI | 1548981806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 30934) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL 30934) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2025-11-19 |