| NPI | 1508022989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA 18170) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2065620) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2008-08-05 |