NPI | 1063608891 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35795) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305205106) |
Enumeration Date | 2007-09-14 |
Last Update Date | 2015-12-07 |