| NPI | 1205833001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT 27407) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070.017127) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2013-02-14 |