| NPI | 1578875423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 35800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 35800) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2019-09-19 |