| NPI | 1720842008 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 247200000X Technician, Other | 
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2105301) | 
| Enumeration Date | 2024-02-07 | 
| Last Update Date | 2025-05-29 |