| NPI | 1013445220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61126496) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA CP026066T) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2024-05-29 |