| NPI | 1053761809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 291334) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 14931) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2019-07-31 |