| NPI | 1083941264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT 00009738) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: ID PT-256) |
| 174H00000X Health Educator (Licence: WA PT00009738) | |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2010-02-19 |