| NPI | 1477569010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT24912) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA pa16970) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-11-30 |