| NPI | 1366981920 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA013620) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 48515) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2024-11-14 |