| NPI | 1689185134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA PTA48964) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE011130) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2017-10-23 |