| NPI | 1962187930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IN 06005419A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306606237) |
| 225200000X Physical Therapy Assistant (Licence: NC DA7784) | |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2023-06-19 |