| NPI | 1861892598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA PT 40323) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT 40323) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2014-08-29 |