| NPI | 1871211128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM PTA0685) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM PTA0685) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2024-03-19 |