| NPI | 1073640587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 11680) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PT 11680) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2011-12-22 |