| NPI | 1306156559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 9724) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR PTA2465) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2019-01-30 |