| NPI | 1588646699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00006248) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00003112) |
| 111N00000X Chiropractor (Licence: CA 23964) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT12673) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2009-04-16 |