| NPI | 1871804724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics (Licence: CA PT15218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT15218) |
| 2251X0800X Physical Therapist Orthopedic (Licence: CA PT15218) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2010-06-25 |