| NPI | 1114224938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA22495) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 007621) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2011-02-14 |