| NPI | 1871467670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 10042) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: RI 01412) |
| Enumeration Date | 2025-10-03 |
| Last Update Date | 2025-10-03 |