| NPI | 1821532631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 09396) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160660710) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2016-12-13 |