| NPI | 1164634192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH 007468) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL 1863) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2023-01-17 |