| NPI | 1497103816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42355) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: CA 42355) |
| 2251S0007X Physical Therapist, Sports (Licence: CA 42355) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 42355) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2016-05-26 |