| NPI | 1609954882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT60436979) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 15229) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2014-02-19 |