| NPI | 1093094211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2080270) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 07254) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2011-08-04 |