| NPI | 1548795123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA010404) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY PTA-A03439) |
| 225200000X Physical Therapy Assistant (Licence: TX 2125051) | |
| 225200000X Physical Therapy Assistant (Licence: MD A4554) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2017-04-20 |