| NPI | 1093172355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY A2472) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA.07789) |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2016-01-18 |