| NPI | 1104364942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA21488) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2119400) |
| 225200000X Physical Therapy Assistant (Licence: CO PTA0013550) | |
| 225200000X Physical Therapy Assistant (Licence: CA 48467) | |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2017-02-01 |