| NPI | 1457621310 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P1 60201170) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2024-07-22 |