| NPI | 1245779842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P160706570) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA PTA48155) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2017-02-15 |