| NPI | 1538375431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 010355-1) |
| 225100000X Physical Therapist (Licence: PA PT-006377-L) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2010-08-06 |