| NPI | 1588476576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502008735) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2025-01-25 |
| Last Update Date | 2025-01-30 |