| NPI | 1467470591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20752) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT 6182) |
| 226300000X Kinesiotherapist (Licence: CA 1562) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-07-07 |