| NPI | 1164539052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00004002) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00004002) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2025-10-16 |