| NPI | 1205085149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT297890) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8150) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2020-02-10 |