| NPI | 1316480981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 9220) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NV A-0930) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2018-03-17 |