| NPI | 1386903581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT-900) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2012-05-08 |