| NPI | 1891305140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 3057-19) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: DC PTA2000046) |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2026-06-17 |