| NPI | 1063809770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P160031087) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 08906) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2015-04-20 |