| NPI | 1730460833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 38337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020327) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2013-02-25 |