| NPI | 1528431376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P1 60573753) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60589118) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2020-10-08 |