| NPI | 1023524154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: WA PT60819888) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WA OR211072) | |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2024-07-25 |