| NPI | 1619294725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA26759) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2127861) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2018-08-27 |