| NPI | 1649639386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH 08244) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2118822) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |