| NPI | 1467743609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID PTA-2839) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P1 60177482) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2011-04-21 |