| NPI | 1922872431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA-1663) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 1663) |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2023-11-14 |