| NPI | 1306238399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 292888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15486) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2017-03-13 |