| NPI | 1679852420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 27777) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 27777) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 27777) | |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2017-04-05 |