| NPI | 1861941643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 226000000X Recreational Therapist Assistant (Licence: FL PTA26290) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NM A-1222) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-22 |