| NPI | 1417318213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 10085) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NV A-0723) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2018-03-17 |