| NPI | 1114125648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA18300) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2125383) |
| 225200000X Physical Therapy Assistant | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2020-09-30 |