| NPI | 1376693903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60751968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT23772) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2017-12-28 |