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 |