| NPI | 1639176431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11425-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: WA PT00005165) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-07-09 |