| NPI | 1619654589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA 61363764) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA 61297242) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2023-06-30 |