| NPI | 1558083790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306604383) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-11-23 |