| NPI | 1447674379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 42551) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42551) |
| 225100000X Physical Therapist (Licence: NV 2862) | |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2024-05-01 |