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 |