| NPI | 1518398635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA24496) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA09268) |
| Enumeration Date | 2013-11-30 |
| Last Update Date | 2013-11-30 |