| NPI | 1831846351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A5790) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 113258-01) |
| 225200000X Physical Therapy Assistant (Licence: TX 2174554) | |
| 225200000X Physical Therapy Assistant (Licence: NY 013631-01) | |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2025-01-07 |