| NPI | 1346257862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00005286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00005286) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-08-14 |