| NPI | 1457799959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 10325A) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT-24845) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2023-02-12 |