| NPI | 1336407071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 20904) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA pta003099) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2013-04-25 |