| NPI | 1073990891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 09165) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160548479) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |