| NPI | 1790239127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 291653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291653) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2020-12-16 |