| NPI | 1295821247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-2824) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2824) |
| 2251S0007X Physical Therapist, Sports (Licence: ID PT-2824) | |
| 225100000X Physical Therapist (Licence: WA PT00009951) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-03-16 |