| NPI | 1366964603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT299700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 32505) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-05-27 |