| NPI | 1164680872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00008200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 322792-2401) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-05-29 |