| NPI | 1205085990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12033) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT60041936) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2024-11-12 |