| NPI | 1013070200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT24624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT24624) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2018-05-24 |