| NPI | 1275077646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT292560) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT292560) |
| 2251H1200X Physical Therapist, Hand (Licence: CA PT292560) | |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2018-06-27 |