| NPI | 1912576380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 013475) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ 17943) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2023-09-04 |