| NPI | 1487853354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60017380) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 18058) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2009-07-29 |