| NPI | 1184021016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT3905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60471943) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2014-11-20 |