| NPI | 1558787754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA22843) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT10217) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2018-01-31 |