| NPI | 1205219201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60669491) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62109) |
| 225100000X Physical Therapist (Licence: NY 038334) | |
| 225100000X Physical Therapist (Licence: CA PT294600) | |
| 225100000X Physical Therapist (Licence: AZ 13656) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2018-04-19 |