| NPI | 1861705576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT 60300653) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 2326PT) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2012-09-14 |