| NPI | 1841780954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA28455) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PTA28455) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |