| NPI | 1538922943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 51525) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P161511504) |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2024-01-31 |