NPI | 1528337060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60439196) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1213293) |
Enumeration Date | 2011-12-28 |
Last Update Date | 2018-03-06 |