| NPI | 1407114143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA 60266820) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 9312) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2012-06-14 |