| NPI | 1720218381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 35483) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 3583) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2022-07-12 |