| NPI | 1457853590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 10811) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT10811) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |