| NPI | 1639653744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A8126) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA28664) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2026-09-14 |