| NPI | 1104072065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: CA 53) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: CA 43805) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 37416) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2016-07-31 |