| NPI | 1417990060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT5808) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PT5808) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2013-02-22 |