| NPI | 1356741011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 09022) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P1 60427509) |
| Enumeration Date | 2014-09-01 |
| Last Update Date | 2014-09-03 |