| NPI | 1407107238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 39389) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39389) |
| 2251S0007X Physical Therapist, Sports (Licence: CA 39389) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2024-03-28 |