| NPI | 1316111032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT34285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA TX60005621) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2019-07-25 |