| NPI | 1194058859 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306601934) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA21550) |
| 225200000X Physical Therapy Assistant (Licence: TX 2067779) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |