| NPI | 1306254370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: WA PT60483349) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: AZ 8685) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |