| NPI | 1215107115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: CA 34627) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17240) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2018-06-08 |