| NPI | 1710105358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: WA PT00008940) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008940) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2023-05-09 |