| NPI | 1578879516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 36828) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 36828) |
| 2251S0007X Physical Therapist, Sports (Licence: CA 36828) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 36828) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 36828) | |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2020-07-10 |