| NPI | 1285885178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1311963) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT29451) |
| 2251C2600X (Licence: CA PT29451) | |
| 2251S0007X Physical Therapist, Sports (Licence: CA PT29451) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: PT29451) | |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2019-07-28 |