| NPI | 1346848769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA29865) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2020-10-16 |
| Last Update Date | 2024-05-08 |