| NPI | 1669595112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 24554) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: CA 24554) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: CA 24554) | |
| 2251S0007X Physical Therapist, Sports (Licence: CA 24554) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 24554) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2010-01-07 |