| NPI | 1356480990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA 00003010) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 200624977) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-09-02 |