| NPI | 1407928344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 03649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007650) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OR 3649) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2016-03-25 |