| NPI | 1740280254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT3697) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: WA PT3697) |
| 2251N0400X Physical Therapist, Neurology | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2017-03-07 |