| NPI | 1558698118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0004091) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60095716) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2021-03-30 |