| NPI | 1558993022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: LA A10979R) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO PTA.0014430) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2023-05-11 |