| NPI | 1871320580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 8323) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 6629) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-09-17 |