| NPI | 1285623942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60780941) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT19433) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2018-06-05 |