| NPI | 1437444130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P160981068) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 7344A) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2020-07-28 |