| NPI | 1568349736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A6130) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC A8240) |
| Enumeration Date | 2025-08-19 |
| Last Update Date | 2025-09-29 |