| NPI | 1295110849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA24658) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2110498) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2015-07-24 |