| NPI | 1629231006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 32263) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2009003414) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2023-02-02 |