| NPI | 1619260866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA.07633) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2078199) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |