| NPI | 1538515762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61352134) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GU PT - 124) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2024-02-09 |