| NPI | 1124028634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT3076) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: WA PT3076) | |
| 2251G0304X Physical Therapist, Geriatrics | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2014-06-09 |