| NPI | 1811392707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60575321) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037891) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2015-07-28 |