| NPI | 1376798470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 24921) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA 24921) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2020-03-11 |