| NPI | 1194281204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT293738) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA PT23062) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2020-03-12 |