| NPI | 1194002519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60106458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.017490) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2011-11-14 |