| NPI | 1841060456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA011987) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A03847) |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-01-04 |