| NPI | 1811314586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61300062) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037437) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2023-05-18 |