| NPI | 1396238317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60865283) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 15655) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-07-03 |