| NPI | 1962618884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT24654) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010812) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT00010812) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2016-09-14 |