| NPI | 1952098808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA31889) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 001595-01) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-04-20 |