| NPI | 1124443767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH 06886) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 10317) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2014-02-18 |