| NPI | 1881914117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 3585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60169739) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2019-04-09 |