| 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 |