| NPI | 1477840965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60219668) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT60219668) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2021-06-07 |