| NPI | 1174889646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA 60064080) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 8678) |
| 225200000X Physical Therapy Assistant (Licence: VA 2306603095) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2012-04-09 |