| NPI | 1063131191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA28218) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 10054) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2023-08-21 |