| NPI | 1649209065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 25727) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 008448) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2009-02-09 |