| NPI | 1598869513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9446) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00009997) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: KS 11-03512) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2005029540) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2015-04-07 |