| NPI | 1174165476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297904) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60961686) |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2021-09-15 |