| NPI | 1346773553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IN 06003875A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA011167) |
| 225200000X Physical Therapy Assistant (Licence: KY A02857) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2017-04-05 |