| NPI | 1164197265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA31333) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2021-08-11 |