| NPI | 1508358839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA D2685277) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2021-06-18 |