| NPI | 1952342602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA PT26095) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT26095) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2011-03-01 |