| NPI | 1902023948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA 19695) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: ME PA2263) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |