| NPI | 1912421751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60754987) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2017-08-02 |