| NPI | 1932680576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 54315) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2140559) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2026-02-10 |