| NPI | 1417916180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 13707) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: CA PT 13707) |
| 2251S0007X Physical Therapist, Sports (Licence: CA PT 13707) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT 13707) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 000080494) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-08 |