| NPI | 1639178361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00005833) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00005833 WA) |
| 2251S0007X Physical Therapist, Sports (Licence: WA PT00005833 WA) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2014-12-16 |