| NPI | 1154740280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA.06891) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306603781) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-16 |