| NPI | 1629143508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 41299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5303) |
| 225100000X Physical Therapist (Licence: VA 2305206761) | |
| Enumeration Date | 2006-11-23 |
| Last Update Date | 2015-03-30 |