| NPI | 1760894075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA 24841) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY PTA A02935) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2016-03-24 |