| NPI | 1235315839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA-06680) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH LMT 33.011673) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-08-26 |