| NPI | 1689852899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 34431) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CA 34431) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2025-06-11 |