| NPI | 1366507162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT22660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 22660) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2015-07-09 |