| NPI | 1730300518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00002838) |
| 225100000X Physical Therapist (Licence: CA PT 10062) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-04-26 |