| NPI | 1063894434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42779) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-03-06 |