| NPI | 1043630205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA24092) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 09025) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2014-04-25 |