| NPI | 1093754608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 24915) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR PT24915) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2016-04-13 |