| NPI | 1053353904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 3833) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009802) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2017-04-04 |