| NPI | 1619571452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306605055) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: VA 2306605055) |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2022-07-12 |