| NPI | 1245891142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 09744) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160615784) |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2019-06-22 |