| 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 |