| NPI | 1740110345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL a011438) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD a4441) |
| Enumeration Date | 2026-05-23 |
| Last Update Date | 2026-05-23 |