| NPI | 1285808667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA 60091956) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2018-11-20 |