| NPI | 1598950206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA001065) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA15969) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2007-09-06 |