| NPI | 1386145415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC P18636) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT294526) |
| 225100000X Physical Therapist (Licence: CA PT294526) | |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2020-12-21 |