| NPI | 1336462225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10733) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT36162) | |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2014-03-19 |