| NPI | 1700196078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 38686) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60192083) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2014-08-26 |