| NPI | 1881141430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 9416) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160677920) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-07-04 |