| NPI | 1245477009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 60076268) |
| 225100000X Physical Therapist (Licence: MA 18509) | |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2019-11-12 |