| NPI | 1295981579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA 60293127) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR 5645) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2013-05-02 |