| NPI | 1700274586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 9487) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 4821) |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2015-01-02 |