| NPI | 1134362486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60475169) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: OR 4716) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OR 4716) | |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2016-12-08 |