| NPI | 1871165811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306001807) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 2653) |
| Enumeration Date | 2021-07-10 |
| Last Update Date | 2021-07-10 |