| NPI | 1780006478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA 33405) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: CA 34405) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2014-01-14 |