| NPI | 1730322355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV 001443) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 06985) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2009-04-13 |