| NPI | 1437567740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT41366) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PT41366) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2022-07-21 |