| NPI | 1427512839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA3965) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA24671) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-01-30 |