| NPI | 1124541016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: CA PT292512) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA 292512) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2024-05-06 |