| NPI | 1578791125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PU60091776) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60099102) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WA PU60091776) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2022-01-10 |