| NPI | 1720244544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA21259) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA10679) |
| 224Z00000X Occupational Therapy Assistant (Licence: GA OTA000825) | |
| 224Z00000X Occupational Therapy Assistant (Licence: SC 2509) | |
| 225200000X Physical Therapy Assistant (Licence: GA PTA002206) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2008-07-31 |