| NPI | 1396347753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA30024) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2022-08-16 |