| NPI | 1972668598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA 27941) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 27941) |
| 2251G0304X Physical Therapist Geriatrics (Licence: CA 27941) | |
| 2251S0007X Physical Therapist Sports (Licence: CA 27941) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2022-03-31 |