| NPI | 1508428145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 300336) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CA 300336) |
| 2251S0007X Physical Therapist, Sports (Licence: MA 24130) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MA 24130) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2021-11-18 |