Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 25468 | CA |
NPI | 1003855776 |
---|---|
Provider Name | Aaron Michael Willis |
First Address | Playa Vista, CA 90094-2040 |
Second Address | Playa Vista, CA 90094-2040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 06/09/2013 |