| NPI | 1952476509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH 08695) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: 1163) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2013-09-30 |