| NPI | 1730151192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA Pt 11766) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 11766) |
| 2251S0007X Physical Therapist, Sports (Licence: CA PT 11766) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 000080302) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2007-07-27 |