| NPI | 1558012302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA CP026582A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 089097) |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2023-12-14 |