| NPI | 1245595685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT60291158) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 6934) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2024-05-29 |