| NPI | 1780172544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60929830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT293820) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2019-08-06 |