NPI | 1992431670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117436) |
Additional Taxonomies | 225200000X Physical Therapy Assistant |
Enumeration Date | 2022-07-26 |
Last Update Date | 2023-07-06 |