| NPI | 1699480673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM PTA1599) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 225200000X Physical Therapy Assistant | |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2023-02-02 |