| NPI | 1275817546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 26924) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT26924) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2020-03-27 |