| NPI | 1386797561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: HI 3612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009114) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2015-03-13 |