| NPI | 1093961435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 33846) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-03834) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2018-03-17 |