| NPI | 1932607942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 00002873) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: WA 00002873) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-01-24 |