| NPI | 1316946148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00005658) |
| Additional Taxonomies | 2251N0400X Physical Therapist Neurology (Licence: WA PT00005658 WA) |
| 2251P0200X Physical Therapist Pediatrics (Licence: WA PT00005658 WA) | |
| 2251S0007X Physical Therapist Sports (Licence: WA PT00005658 WA) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: WA PT00005658 WA) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2007-07-09 |