| NPI | 1770834665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299318) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1217753) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2020-11-06 |