| NPI | 1689793473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 32747) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 20870) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2025-09-11 |