| NPI | 1982023370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: WA PT60814764) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA 41067) |
| 2251X0800X Physical Therapist Orthopedic (Licence: CA PT41067) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2021-03-31 |