| NPI | 1255844916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 35351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60648721) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2021-04-08 |