| NPI | 1154499721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT16267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5207) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2022-06-02 |