| NPI | 1174552343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 00009962) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 016736) |
| 225100000X Physical Therapist | |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2019-08-19 |