| NPI | 1790343739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR CP000275A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2018026092) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2019-06-04 |