| NPI | 1023379187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA 10214) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 2336) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |