| NPI | 1376741488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P160043884) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00004285) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2012-05-14 |