| NPI | 1740998434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NV A-1516) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 53320) |
| 225700000X Massage Therapist (Licence: NV NVMT.5574) | |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2025-01-09 |