| NPI | 1124040423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 17213) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT 17213) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2011-10-11 |