| NPI | 1154660728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA23032) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 10213A) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2013-07-05 |