| NPI | 1538619838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40698) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 8848) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2016-10-11 |