| NPI | 1215086947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 7665) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00006489) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |