| NPI | 1952790891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61011077) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA 60168280) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2019-11-23 |