| NPI | 1902482995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC TA8246) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 009563) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2023-09-08 |