| NPI | 1033567466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3316) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 60717697) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2020-01-23 |