| NPI | 1225684939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60571927) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2019-08-18 |
| Last Update Date | 2019-08-18 |