| NPI | 1952420549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT11906) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 22308) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA pt11906) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2024-09-18 |