| NPI | 1588086409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CA 34816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34816) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 34816) | |
| Enumeration Date | 2014-01-11 |
| Last Update Date | 2014-10-28 |