| NPI | 1699033308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60265996) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 32022) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2014-01-30 |