| NPI | 1558630087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P1 60039334) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 7706) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2011-12-29 |