| NPI | 1174950356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 60789) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT 60390851) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2023-10-01 |