| NPI | 1861552747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60108164) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01915) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2010-03-10 |