| NPI | 1285090134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 43445) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA PT 43445) |
| 2251S0007X Physical Therapist Sports (Licence: CA PT 43445) | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2016-07-28 |