| NPI | 1285025304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA000935) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA11413) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |