| NPI | 1952104739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: RI PTA01340) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA33874) |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-03-28 |