| NPI | 1598887127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A4994) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 1058) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2013-02-14 |