| NPI | 1467746883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI000013) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA 05648) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2011-06-02 |