| NPI | 1356724637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT42425) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT42125) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2022-09-23 |