| NPI | 1104292044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT294285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015028950) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2018-04-19 |