| NPI | 1205164480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA p1 60041032) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NH 0738) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2009-12-17 |