| NPI | 1477585578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 14052) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA mfc 46173) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-12-16 |