| NPI | 1366166928 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV 002550) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 012123) |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-09-28 |