| NPI | 1659251403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 34333) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A5762) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-09-11 |