| NPI | 1174686539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 19995) |
| Additional Taxonomies | 2251E1200X Physical Therapist Ergonomics |
| 2251G0304X Physical Therapist Geriatrics | |
| 2251N0400X Physical Therapist Neurology | |
| 2251S0007X Physical Therapist Sports | |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2012-03-05 |