| NPI | 1407304405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 48894) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE009934) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2019-07-19 |