| NPI | 1164595708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY PTAA01896) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA05511) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |