| NPI | 1396289328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA 26297) |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2021-11-24 |