| NPI | 1174682066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT22909) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA PT22909) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2021-10-14 |