| NPI | 1245782143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60292434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038775) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-10-27 |