| NPI | 1760145312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 9881) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: OR 9881) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2021-10-25 |