| NPI | 1669996864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 1416172) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: KS 197780) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2022-11-22 |