| NPI | 1225104904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P160197428) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR PTA1988) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2013-01-23 |