| NPI | 1063996312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 09670) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160856867) |
| Enumeration Date | 2018-09-22 |
| Last Update Date | 2018-09-22 |