| NPI | 1972956217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306604399) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 10415) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |