| NPI | 1679926166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2133780) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: MD A4492) |
| 225200000X Physical Therapy Assistant (Licence: MD A4492) | |
| 225200000X Physical Therapy Assistant (Licence: PA TEI005154) | |
| 226300000X Kinesiotherapist | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2022-11-12 |