| NPI | 1184006371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI005312) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 04124) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-01-26 |