| NPI | 1336269463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT23806) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2021-03-03 |