| NPI | 1235621343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT60842262) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2021-08-09 |