| NPI | 1285963744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 766) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: WA P1 60033015) |
| Enumeration Date | 2009-12-12 |
| Last Update Date | 2021-09-03 |