| NPI | 1790522217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306604643) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 49855) |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2024-07-11 |