| NPI | 1871186494 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225200000X Physical Therapy Assistant | 
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502003708) | 
| Enumeration Date | 2021-02-15 | 
| Last Update Date | 2021-02-17 |