| NPI | 1053370239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT24454) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: CA PT24454) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2022-01-05 |