| NPI | 1912104472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 34617) |
| Additional Taxonomies | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: CA 34617) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 34617) | |
| 2251E1200X Physical Therapist, Ergonomics (Licence: CA 34617) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: CA 34617) | |
| 2251N0400X Physical Therapist, Neurology (Licence: CA 34617) | |
| 2251S0007X Physical Therapist, Sports (Licence: CA 34617) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2014-09-29 |