| NPI | 1639567027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2011003280) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2022954) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2025-05-06 |