| NPI | 1952794059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT42342) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: CA 42342) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-09-10 |