NPI | 1770788978 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT32946) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 060402704) |
Enumeration Date | 2007-06-18 |
Last Update Date | 2022-01-03 |