| NPI | 1487739025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT18593B) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 18539) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2012-09-13 |