| NPI | 1659565422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 7334) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA 20322) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-10-08 |