| NPI | 1629110507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA 19118) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL Al 1419) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |