| NPI | 1578997607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60727805) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12446) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2024-02-21 |