| NPI | 1245484658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA21022) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 21022) |
| 225200000X Physical Therapy Assistant (Licence: CA 6693) | |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2020-01-13 |