| NPI | 1598098139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA CA#24879) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: CA C.Ped.#1258) |
| 225100000X Physical Therapist (Licence: NV #1414) | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2009-09-15 |