| NPI | 1922544600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P160719840) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: ID 4839) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-01-19 |