| NPI | 1326439381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 33288) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA001569) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2025-08-19 |