| NPI | 1962390443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SD 0631) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 1287) |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2025-06-25 |