| NPI | 1831657253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA PTA49277) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA003736) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2019-03-05 |