| NPI | 1770648198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00009466) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 020402141) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2015-06-09 |