| NPI | 1114325263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 53290) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE010342) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2024-08-21 |