| NPI | 1134309073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT 60282422) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 8916) |
| 225100000X Physical Therapist (Licence: TX 1173970) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: RI PT01812) | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2021-06-23 |