NPI | 1720064355 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 14189) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
2251X0800X Physical Therapist, Orthopedic (Licence: CA PT 14189) | |
Enumeration Date | 2005-12-15 |
Last Update Date | 2007-07-08 |