| NPI | 1861682858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY CP022115A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 02829) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2023-06-02 |