| NPI | 1427555283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA20275) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA CPO21737A) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2023-05-09 |