| NPI | 1902374119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA23614) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2143729) |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2023-06-26 |