| NPI | 1407255755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 10851) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: CA 10851) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 10851) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |