| NPI | 1366082000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA PTA48426) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA p) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-01-10 |