| NPI | 1841564754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics (Licence: CA PT22344) |
| Additional Taxonomies | 2251E1300X Physical Therapist Electrophysiology, Clinical (Licence: CA PT22344) |
| 2251S0007X Physical Therapist Sports (Licence: CA PT22344) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: CA PT22344) | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2012-02-24 |