| NPI | 1639449663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 38500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38500) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2023-08-16 |