| NPI | 1801774963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN PTA7291) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL PTA8644) |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-08-25 |