| NPI | 1609927649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 1303PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00000648) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |