| NPI | 1033582564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA25248) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 09432) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2015-11-05 |