| NPI | 1295112514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8975) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60544884) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2018-03-17 |