| NPI | 1619368131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM A-0783) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SD 0698) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2023-06-22 |