| NPI | 1013651587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA 61297488) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2022-04-25 |