| NPI | 1447570809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PU 60159680) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: WA PU 60159680) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2020-01-28 |