| NPI | 1255530358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00007639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-2143) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2010-04-01 |